No pain, no gain revisited: the impact of positive and negative psychotherapy experiences on treatment outcome
Open accessAbstract
Objective: Psychotherapy may have many benefits for patients with mental health problems, but patients may also have negative experiences related to the therapy. Not much is known about these negative psychotherapy experiences and their impact on treatment outcome. The aim of this study was to examine the association between positive and negative psychotherapy experiences and treatment outcome. Methods: A total of 130 patients participated in the study. They received treatment as usual and were assessed for positive and negative psychotherapy experiences at mid-treatment and post-treatment using the Positive and Negative Experiences of Psychotherapy Questionnaire (PNEP). Treatment outcome was measured by the Outcome Questionnaire - 45 (OQ-45). Multiple linear regression was used to analyze the data. Results: All patients reported positive psychotherapy experiences at mid-treatment. At least one negative experience was reported by 69% of participants. After correction for baseline severity (i.e., OQ-45 at baseline) and relevant demographic variables, positive psychotherapy experiences at mid-treatment emerged as a predictor for treatment outcome. In contrast, negative psychotherapy experiences did not predict treatment outcome. However, reporting more negative experiences was associated with reporting fewer positive experiences at mid- and end of treatment. Conclusion: Both positive and negative psychotherapy experiences commonly occur. Although in this study negative psychotherapy experiences did not predict treatment outcome in terms of symptom reduction, the findings do suggest that negative experiences may influence the way in which patients evaluate their treatment. Although positive experiences outweigh negative experiences, patients should be informed that negative experiences may also occur.
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Evidence suggests that adverse events can trigger dropouts [66].
“evidence suggests that the former can trigger the latter [66].”
From Habit as a therapeutic component in psychological treatment for obsessive-compulsive disorder: A randomised controlled feasibility study. (2026) · cites this paper as [66]
The Introduction discusses adverse events and treatment outcomes, but does not link adverse events to dropout. The Methods (Participants; page unavailable) reports study dropout after questionnaire non-response, without attributing it to adverse events. Searches for dropout, premature termination, and negative experiences found no passage making the claimed connection. (LLM, conf=0.74)
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- Authors
- Verkooyen, R., Broers, N. J., & Dandachi-FitzGerald, B.
- Affiliations
- Zuyderland Medisch Centrum (NL)
- Maastricht University (NL)
- ORCID
- Broers, Nick J.
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2024-06-18
- Volume
- 15
- Pages
- 1378456-1378456
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC11220492
- OpenAlex
- W4399811936
- Cited by
- 18
- References
- 60
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 1
- FWCI
- 9.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- DSpace (Open University in the Netherlands) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- psychotherapy experience, treatment outcomes, mental illness, symptom relief, OQ-45, baseline symptom severity
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